Page 1300 - Clinical Small Animal Internal Medicine

1238 Section 11 Oncologic Disease

aspiration may help guide treatment if blood dyscrasias protocol incorporating a drug with CNS penetration
VetBooks.ir are present. (such as CCNU) is recommended.
Thoracic +/‐ abdominal radiographs or preferably
abdominal ultrasound are recommended to determine
Central nervous system lymphoma should be treated
the presence and extent of disease within visceral organs. Central Nervous System Lymphoma
with chemotherapy or radiation therapy emergently as
clinical signs, particularly paralysis, may become perma­
Therapy
nent if treatment is delayed.
There is less known about multicentric lymphoma treat­
ment protocols in the cat relative to the dog. While suc­
cess of the various chemotherapy protocols is highly
variable, the majority are capable of inducing a first
remission of >6 months after induction. Protocol choice Table 134.3 Modified COP protocol for treatment of feline
lymphoma
is based on cell type/grade.
Treatment week Drug, dosage, and route
Small Cell or Low‐Grade Lymphoma
Cats with a well‐differentiated or small cell form of 1 CBC/chemistry profile/ Vincristine 0.5–0.6 mg/M 2
lymphoma can have an excellent prognosis, and may UA as baseline prior to Cyclophosphamide 200 mg/M 2
survive for prolonged periods, with chlorambucil and therapy Prednisolone 2 mg/kg daily
prednisolone. 2 Pretreatment CBC/plt Vincristine 0.5–0.6 mg/M 2
Prednisolone 2 mg/kg daily
Large Cell or High‐Grade Lymphoma 3 Pretreatment CBC/plt Vincristine 0.5–0.6 mg/M 2
Similar to the dog, drugs with established activity in inter­ Prednisolone 1 mg/kg daily
mediate and high‐grade lymphomas include cyclophos­ 4 Pretreatment CBC/plt Vincristine 0.5–0.6 mg/M 2
a
phamide (C), doxorubicin (H, hydroxydaunorubicin or and renal profile with USG if Cyclophosphamide 200 mg/M 2
doxorubicin), vincristine (O, Oncovin®,), methotrexate, using doxorubicin OR substitute with doxorubicin
CCNU (lomustine) and prednisone (P). Multiple proto­ (1 mg/kg) if not in clinical
remission
cols incorporate these drugs as first‐ or second‐line treat­ Prednisolone 1 mg/kg daily
ments and are considered a COP‐ or CHOP‐based 5/6 Posttreatment CBC/plt Restage with ultrasound and/or
protocol, depending on the drugs used. These multiagent thoracic radiographs
chemotherapy protocols are used commonly for cats with 7 Pretreatment CBC/plt Vincristine 0.5–0.6 mg/M 2
intermediate to large cell (high‐grade) lymphoma of any Cyclophosphamide 200 mg/M 2
anatomic location (Table 134.3). Currently, few data exist Prednisolone 1 mg/kg daily
to compare outcomes using the various modifications of 8/9 No treatment
treatment for cats; consequently a protocol may be based 10 Pretreatment CBC/plt Vincristine 0.5–0.6 mg/M 2
on client/veterinarian preference. Cyclophosphamide 200 mg/M 2
Unlike canine lymphoma, in which chemotherapy is Prednisolone 1 mg/kg daily
often discontinued after a period of time as long as the 11/12 No treatment
pet continues to be in remission, comparable data do not 13 Pretreatment CBC/plt Vincristine 0.5–0.6 mg/M 2
exist in the cat. Consequently, many cats continue to Cyclophosphamide 200 mg/M 2
receive maintenance chemotherapy for up to a year or Prednisolone 1 mg/kg daily
longer. Also unlike in humans and dogs receiving 14/15 No treatment
doxorubicin‐based protocols, cats are at low risk for car­ Restage when clinically
diotoxicity though they are susceptible to its renal toxic indicated
effect. Renal function must be monitored with BUN, cre­ 16 Pretreatment CBC/plt Vincristine 0.5–0.6 mg/M 2
atinine, and urine specific gravity, ideally before each Cyclophosphamide 200 mg/M 2
treatment with doxorubicin. Corticosteroids may exac­ Prednisolone 1 mg/kg daily b
erbate cardiomyopathy in cats and these drugs should be a If a clinical remission has not been achieved by week 4, then
avoided or used conservatively in patients with clinical substitute with doxorubicin and alternate with vincristine/
or subclinical heart disease. cyclophosphamide. Use doxorubicin only if adequate renal function
has been established with renal profile and urine specific gravity.
b Continue every three weeks until relapse or for one year of
Renal Lymphoma continuous remission.
Because many cats with renal lymphoma have or will CBC, complete blood count; plt, platelets; UA, urine analysis;
develop CNS involvement, treatment with a multiagent USG, urine specific gravity.